1131-P: Clinical, Demographic, Provider, and Formulary Characteristics Associated with Initiation of a SGLT2i or GLP-1RA among Medicare Beneficiaries with Type 2 Diabetes on Prior Oral Agents: A Cohort Study

Using 2014-2016 claims data from a random 5% sample of Medicare beneficiaries, we sought to describe characteristics associated with initiation of a SLT2i or GLP-1RA, focusing on measures of plan generosity (e.g., the number of drugs covered with no or minimal copays). Our cohort included beneficiaries with type 2 diabetes who had at least 1 prescription claim for an oral diabetes medication in the 180 days before the start of follow-up (1/1/2015). To identify new initiators of these agents, we excluded beneficiaries who filled any insulin, SGLT2i or GLP-1RA prior to the index date or who died before 12/31/16. We developed multivariable logistic regression models controlling a priori for age, race, region, prior medication use, claims-based measures of diabetes severity and clinical comorbidities, provider specialty and measures of formulary generosity. Of 103,112 eligible beneficiaries (mean age 73, 57% female), 5,076 (4.9%) initiated a SGLT2i or GLP-1RA between 1/1/15-12/31/16. After adjusting for all baseline characteristics, beneficiaries in plans covering 2 or more target drugs in preferred tiers (i.e., 1-3) were more likely (adjusted odds ratio [aOR] 1.18 [95% CI, 1.05 to 1.32]) to initiate one of these medications than patients enrolled in plans covering 0 drugs. Other characteristics associated with higher odds included: age<65 (aOR 1.78 [95% CI, 1.64 to 1.92]), diabetic retinopathy (aOR 1.19 [95% CI, 1.08 to 1.31], obesity (aOR 1.49 [95% CI, 1.38 to 1.62) and having baseline medications prescribed by an endocrinologist (aOR 1.68 [95% CI, 1.49 to 1.89]. Black race (aOR 0.66 [95% CI, 0.60 to 0.73]) and CKD (aOR 0.84 [95% CI, 0.76 to 0.92]) were associated with lower risk of initiation. After controlling for a large number of prespecified covariates, Medicare beneficiaries with type 2 diabetes with more generous prescription drug coverage were more likely to initiate a SGLT2i or GLP-1RA.